Healthcare Provider Details

I. General information

NPI: 1750938247
Provider Name (Legal Business Name): JOEL E TELLEZ QUIROGA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/20/2019
Last Update Date: 11/26/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5802 SARATOGA BLVD STE 200
CORPUS CHRISTI TX
78414-4252
US

IV. Provider business mailing address

849 KELLOGG AVE
JANESVILLE WI
53546-2808
US

V. Phone/Fax

Practice location:
  • Phone: 361-986-4600
  • Fax:
Mailing address:
  • Phone: 608-755-7960
  • Fax: 608-755-7873

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberV3121
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: